Provider Demographics
NPI:1073695680
Name:SIDNEY HEALTH CENTER
Entity Type:Organization
Organization Name:SIDNEY HEALTH CENTER
Other - Org Name:DURAMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-488-2118
Mailing Address - Street 1:216 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3519
Mailing Address - Country:US
Mailing Address - Phone:406-488-2566
Mailing Address - Fax:406-488-2565
Practice Address - Street 1:214 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4126
Practice Address - Country:US
Practice Address - Phone:406-488-2566
Practice Address - Fax:406-488-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10905332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000081628OtherBC/BS
MT5601076Medicaid
MT0296740001Medicare NSC